Synonym: malignant neuroleptic syndrome Show
What is neuroleptic malignant syndrome?Neuroleptic malignant syndrome is a rare but potentially life-threatening idiosyncratic reaction to antipsychotic drugs[1]. It causes fever, muscular rigidity, altered mental status and autonomic dysfunction. The syndrome is usually associated with potent neuroleptics such as haloperidol and fluphenazine. The underlying pathological abnormality is thought to be central D2 receptor blockade or dopamine depletion in the hypothalamus and nigrostriatal/spinal pathways. This leads to an elevated temperature set-point, impairment of normal thermal homeostasis and extrapyramidally induced muscle rigidity. However, this does not explain why it sometimes occurs with low-potency neuroleptic drugs or other medication without known antidopaminergic activity. It is thought that other mechanisms such as changes in skeletal muscle calcium metabolism or sympathoadrenal hyperactivity may be involved. The condition shares many features with the serotonin syndrome and malignant hyperpyrexia. It presents a diagnostic challenge. Epidemiology[2]
Risk factors for developing neuroleptic malignant syndrome[2]
Neuroleptic malignant syndrome symptoms
Neuroleptic malignant syndrome is most common after initiation or increase in dosage of neuroleptic therapy and in 90% of cases this occurs within 10 days[6]. The onset is usually gradual over 1 to 3 days and tends to occur within four weeks of starting or increasing neuroleptic medication. However, it can occur at any time in those taking neuroleptics. There is always a history of taking neuroleptics or other relevant agents within the preceding four weeks. Symptoms can persist for up to 5 to10 days after discontinuation of the offending drug, or longer if depot medication. Signs
Diagnostic features of neuroleptic malignant syndrome[7]
Differential diagnosis
Investigations[2, 6]
Neuroleptic malignant syndrome treatment[8]Neuroleptic malignant syndrome is best considered as a medical emergency and managed in an acute hospital[9]. Airway and breathing need to be protected if there is evidence of compromise. Severe cases may require circulatory and ventilatory support.
Prognosis[2, 10]Mortality has reduced from 20-30% and is now reported as 5-11.6%. Death is usually caused by cardiovascular collapse, respiratory failure, myoglobinuric acute kidney injury, arrhythmias or diffuse intravascular coagulation. Morbidity results from respiratory failure, acute kidney injury, seizures and arrhythmia. Respiratory changes, severity of hyperthermia, and older age have been found to be associated with a higher mortality[1]. If acute kidney injury develops during an episode of neuroleptic malignant syndrome this increases mortality up to 50%. Once oral neuroleptics are stopped, the condition can last for 2-14 days; for depot neuroleptics, the period may be up to 21 days. The outlook is good on the whole if there:
Complications[2, 11]
Neuroleptic malignant syndrome prevention[12]
How does antipsychotics cause neuroleptic malignant syndrome?This theory is supported by the observation that the primary cause of NMS is the use of antipsychotic drugs that specifically block dopamine receptors, and in particular D2 receptors, and that the syndrome can also be induced by abrupt dopamine withdrawal.
What happens in neuroleptic malignant syndrome?INTRODUCTION Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic emergency associated with the use of antipsychotic (neuroleptic) agents and characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia.
What is neuroleptic malignant syndrome ?( cause and treatment?Neuroleptic malignant syndrome (NMS) is a rare reaction to antipsychotic drugs that treat schizophrenia, bipolar disorder, and other mental health conditions. It affects the nervous system and causes symptoms like a high fever and muscle stiffness. The condition is serious, but it's treatable.
What are the symptoms of neuroleptic syndrome?What are the symptoms of neuroleptic malignant syndrome?. Very high fever (102 to 104 degrees Fahrenheit).. Irregular heartbeat (arrhythmia).. Fast heart rate (tachycardia).. Rapid breathing (tachypnea).. Muscle rigidity (stiffness).. Altered mental status.. High blood pressure or low blood pressure.. Excessive sweating.. |